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Washington-area hospitals, alerted to the possibility of chemical or biological attacks on the region in the wake of the Sept. 11 tragedies, are moving quickly to update emergency plans and prepare doctors and nurses for such a crisis.

At the Georgetown University Medical Center, Dr. Eric Glasser, the emergency-preparedness plan manager,said the hospital's contingency plan is being "fine-tuned" in the wake of the attacks.

"In terms of the commitment by hospital administrators, it has been a 100 percent change not so much in the plan, but in terms of education."

Because symptoms of a biological-weapons attack can resemble the flu and often don't manifest themselves until days or even weeks after exposure, hospital workers likely would be the first line of detection and defense. There have been three seminars at Georgetown since Sept. 11 to train personnel to recognize symptoms as soon as possible.

"I think from the hospital standpoint, the physicians and nurses and lab technicians are all gearing up for something we pray we don't have to deal with," said Dr. Christopher Wuerker, chairman of the emergency-management committee for the Washington Hospital Center.

Dr. Wuerker said the Washington Hospital Center convened a task force in 1999 to address biological terrorism. The hospital created response scenarios for small, large or massive attacks, with priorities on identifying potential agents, assessing the threat of each and managing those who have been exposed. Since the Sept. 11 attacks, staff meetings have been held to update personnel on the latest information about biological agents.

"In the simple cases, the hospitals are well-geared to deal with patients that have a contagious illness," Dr. Wuerker said, adding that there are ways to convert the facility to deal with the fallout of massive exposure to a biological agent.

Dr. Luciana Borio, a fellow at the Johns Hopkins University Center for Civilian Biodefense Studies, agreed that awareness of the threat of biological weapons is the first step in preparing a response.

"Physicians aren't used to thinking that way, that their patients have been the victim of a malicious attack," she said. That attitude, she added, leaves hospitals and physicians unprepared.

Dr. Keith Holtermann, the assistant dean for health sciences at George Washington University, said the university's medical centerhas faculty with training in nuclear, biological and chemical exposure, and that may give the center an edge in detection. In a majority of hospitals though, he said, there aren't electronic records, so spotting a series of similar cases might be a matter of chance.

"Bottom line is this: There's not a protocol for community hospitals, or even university hospitals, for detecting this," he said.

Plus, he said years of cost cutting in the nation's hospitals have eroded the capacity to handle a massive attack.

"What we've done is we've squeezed out a lot of the excess capacity in the system. In the old days, if we needed an extra 100 or 200 beds in a hospital, that was relatively easy to attain," he said. "In the case of a high-scale, high-impact event, are the hospitals prepared to bring out that extra capacity as they were in the past? The answer is no."

Dr. Holtermann said hospitals need to strengthen the systems they use every day so that in the face of a crisis, they can expand and react.

"You don't want to spend resources in making a plan that only works in this once-in-a-lifetime situation," he said.

The Johns Hopkins Center has identified anthrax, botulinus toxin, plague, smallpox and tularemia as five "widely known and feared [biological agents] that would cause disease and deaths in sufficient numbers to cripple a city."

Anthrax, according to Dr. Borio, "fits all the major criteria" for use in a biological attack. She said anthrax spores are attainable, relatively stable and have an antidote available making them less dangerous to work with.

Exposure to an aerosol of anthrax spores could manifest symptoms as soon as two days after. Illness could also develop as late as 6 to 8 weeks after exposure. Once the symptoms reveal themselves, death is only about one to three days away for most people.

A 1993 report by the U.S. Congressional Office of Technology Assessment estimated that the aerosolized release of 100 kgs., or about 225 lbs., of anthrax spores upwind of the D.C. metropolitan area could result in between 130,000 and 3 million deaths.

But Milton Leitenberg, a senior research scholar with the University of Maryland School of Public Affairs, said those numbers are a "highest-end estimate." The possibility of a terrorist attack using biological weapons is as unlikely now as it was a month or a year ago because, he said, refining an agent such as anthrax into a weapon is not easy to do.

The lone bacterial attack in America was in 1984, when followers of Bhagwan Shree Rajneesh used salmonella, a nonlethal bacterial agent, to poison 10 salad bars in Dalles, Ore., causing 700 people to fall ill. The Rajneesh sect wanted to make people too sick to vote in a local election, the outcome of which it believed was critical to its religious commune's interests.